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Lawan A, Aubertin A, Mical J, Hum J, Graf ML, Marley P, Bolton Z, Walton DM. Is educational attainment associated with the onset and outcomes of low back pain? a systematic review and meta-analysis. PLoS One 2024; 19:e0308625. [PMID: 39137213 PMCID: PMC11321572 DOI: 10.1371/journal.pone.0308625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is the leading global cause of years lived with disability. Of the biopsychosocial domains of health, social determinants of LBP remain under-researched. Socioeconomic status (SES) may be associated with the onset of new LBP or outcomes of acute LBP, with educational attainment (EA) being a key component of SES. The association between EA and LBP has yet to be the subject of a dedicated review and meta-analysis. PURPOSE To review evidence of the association between EA and a) onset or b) outcomes of acute and subacute LBP in the adult general population and to conduct statistical pooling of data where possible. METHODS An electronic search was conducted in MEDLINE, Embase, CINAHL, and ProQuest from inception to 2nd November 2023 including reference lists to identify relevant prospective studies. Risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool. Where adequate data were available, estimates were pooled using a random-effects meta-analysis. Overall evidence for each outcome was graded using an adapted GRADE. RESULTS After screening 8498 studies, 29 were included in the review. Study confounding and attrition were common biases. Data from 19 studies were statistically pooled to explore EA as a predictor of new LBP onset or as prognostic for outcomes of acute or subacute LBP. Pooled results showed no association between EA and the onset of new LBP (OR: 0.927, 95%CI: 0.747 to 1.150; I2 = 0%). For predicting outcomes of acute LBP, compared to those with no more than secondary-level education, post-secondary education or higher was associated with better outcomes of pain (OR: 0.538, 95%CI: 0.432 to 0.671; I2 = 35%) or disability (OR: 0.565, 95%CI: 0.420 to 0.759; I2 = 44%). High heterogeneity (I2>80%) prevented meaningful pooling of estimates for subacute LBP outcomes. CONCLUSION We found no consistent evidence that lower EA increases the risk of LBP onset. Lower EA shows a consistent association with worse LBP outcomes measured at least 3 months later after acute onset with inconclusive findings in subacute LBP. Causation cannot be supported owing to study designs. High-quality research is needed on potential mechanisms to explain these effects.
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Affiliation(s)
- Aliyu Lawan
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Alex Aubertin
- School of Health Sciences, Nursing and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
| | - Jane Mical
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Joanne Hum
- Palliative Care, Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Michelle L. Graf
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Marley
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Zachary Bolton
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - David M. Walton
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
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Mesa-Castrillon CI, Beckenkamp PR, Ferreira M, Simic M, Davis PR, Michell A, Pappas E, Luscombe G, Noronha MD, Ferreira P. Global prevalence of musculoskeletal pain in rural and urban populations. A systematic review with meta-analysis. Musculoskeletal pain in rural and urban populations. Aust J Rural Health 2024. [PMID: 38963186 DOI: 10.1111/ajr.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/10/2024] [Accepted: 06/16/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION To systematically compare the global prevalence of musculoskeletal pain and care-seeking in rural and urban populations. METHODS A systematic review with meta-analysis of observational studies reporting a direct comparison of rural and urban populations was conducted worldwide and included back, knee, hip, shoulder, neck pain and a broad diagnosis of 'musculoskeletal pain'. A search strategy combining terms related to 'prevalence', 'musculoskeletal pain' and 'rural' was used on the following databases: MEDLINE, Embase, CINAHL, Scopus, and rural and remote health from their inception to 1 June 2022. Random-effects meta-analysis was used to pool the data. Results were presented as odds ratios (OR) along with 95% confidence intervals (95% CI). RESULTS A total of 42 studies from 24 countries were included with a total population of 489 439 participants. The quality scores for the included studies, using the modified Newcastle Ottawa Scale tool, showed an average score of 0.78/1, which represents an overall good quality. The pooled analysis showed statistically greater odds of hip (OR = 1.62, 95% CI = 1.23-2.15), shoulder (OR = 1.42, 95% CI = 1.06-1.90) and overall musculoskeletal pain (OR = 1.26, 95% CI = 1.08-1.47) in rural populations compared to urban populations. Although the odds of seeking treatment were higher in rural populations this relationship was not statistically significant (OR = 0.76, 95% CI = 0.55-1.03). CONCLUSION Very low-certainty evidence suggests that musculoskeletal, hip and shoulder pain are more prevalent in rural than urban areas, although neck, back and knee pain, along with care-seeking, showed no significant difference between these populations. Strategies aimed to reduce the burden of musculoskeletal pain should consider the specific needs and limited access to quality evidence-based care for musculoskeletal pain of rural populations.
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Affiliation(s)
- Carlos I Mesa-Castrillon
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange Campus, Orange, New South Wales, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela Ferreira
- School of Health Sciences, Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Milena Simic
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Phillip R Davis
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Antonio Michell
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- The University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgina Luscombe
- School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange Campus, Orange, New South Wales, Australia
| | - Marcos De Noronha
- Rural Department of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
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Mesa-Castrillon CI, Simic M, Ferreira ML, Bennell KL, Luscombe GM, Gater K, Beckenkamp PR, Michell A, Bauman A, de Luca K, Bunker S, Clavisi O, Ferreira PH. Effectiveness of an eHealth-Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2024; 76:570-581. [PMID: 37984995 DOI: 10.1002/acr.25272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/08/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Our objective was to evaluate the effectiveness of a three-month physiotherapist-delivered eHealth physical activity program compared with usual care to improve function in adults with low back pain or knee osteoarthritis in rural Australia. METHODS This was a parallel, two-group, pragmatic, superiority, randomized controlled trial involving three- and six-month posttreatment follow-ups. There was a total of 156 adults with chronic nonspecific low back pain (n = 97) or knee osteoarthritis (n = 59) from rural Australia. The intervention involved an eHealth physical activity and an exercise program that included five to eight teleconsultations with a physiotherapist (primary time point three months) or usual care (eg, general practitioner, physiotherapy, and pain medication). The primary outcome was the Patient-Specific Functional Scale (0-30), with a three-point difference between groups being considered the minimum clinically important difference. RESULTS Participants receiving the eHealth intervention (n = 78) reported significantly greater and clinically worthwhile improvements in function (mean between-group difference 3.6; 95% confidence interval [CI] 1.3-5.9) compared to participants receiving usual care (n = 78). Small but statistically significantly greater improvements in disability (7.2 of 100; 95% CI 2.1-12.3) and quality of life (4.5 of 100; 95% CI 0.0-9.0) also favored the eHealth group. No clinical or statistical differences between groups were found for the secondary outcomes of pain, coping skills, and physical activity levels. CONCLUSION A physiotherapist-delivered eHealth intervention is effective and provides clinically meaningful improvements in function compared to usual care for people with musculoskeletal pain in rural communities. These findings highlight the potential for eHealth-based programs to improve access to evidence-based exercise interventions for people with musculoskeletal pain in rural communities.
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Affiliation(s)
- Carlos I Mesa-Castrillon
- University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Milena Simic
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Kim L Bennell
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Kristy Gater
- Dubbo Health Service, Dubbo, New South Wales, Australia
| | | | | | - Adrian Bauman
- University of Sydney, Sydney, New South Wales, Australia
| | - Katie de Luca
- Central Queensland University Brisbane, Queensland, Australia
| | | | | | - Paulo H Ferreira
- University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Crockett K, Lovo S, Irvine A, Trask C, Oosman S, McKinney V, McDonald T, Sari N, Martinez-Rueda R, Aiyer H, Carnegie B, Custer M, McIntosh S, Bath B. "Navigating chaos": Urban, Rural, and Remote Patient Experiences in Accessing Healthcare with Indigenous and Non-Indigenous Perspectives of Living with Chronic Low Back Pain. Can J Pain 2024; 8:2318706. [PMID: 38616950 PMCID: PMC11008541 DOI: 10.1080/24740527.2024.2318706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
Background Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient-provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.
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Affiliation(s)
- Katie Crockett
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey Lovo
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alison Irvine
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine Trask
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology, & Health, Royal Institute of Technology, Stockholm, Sweden
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sarah Oosman
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Veronica McKinney
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Terrence McDonald
- Department of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Calgary, Alberta, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rosmary Martinez-Rueda
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Harini Aiyer
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Bertha Carnegie
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marie Custer
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey McIntosh
- Patient Partner, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brenna Bath
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Surís X, Ortiz-Santamaria V, Pueyo-Sánchez MJ, Mompart-Penina A, Larrosa M, Ricart A. Decreasing prevalence of chronic back pain in Catalonia. Analysis of the Catalan Health Survey. Public Health 2022; 206:38-45. [PMID: 35349966 DOI: 10.1016/j.puhe.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Chronic back pain is one of the main health problems reported by the adult population and its prevalence is influenced by different sociodemographic, work and lifestyle-related factors. The aim of this study was to describe the trend in the lifetime prevalence of chronic back pain in the adult Catalan population between 2011 and 2018 and its associated factors. STUDY DESIGN Cross-sectional study. Secondary analysis of a health survey. METHODS Trend in lifetime prevalence of chronic back pain by age and sex groups was estimated from the Catalan Health Survey. Association of chronic back pain with sex, age, health status, lifestyle factors, comorbidities, socio-economic and work-related variables was analysed. RESULTS A total of 31,823 people were interviewed between 2011 and 2018. The prevalence of chronic back pain decreased from 29.7% to 24.2% between 2011-2014 and 2015-2018 in the total population with higher prevalence and a greater difference in women (35%-28.50%) than in men (24.2%-19.7%). Factors associated with higher prevalence of chronic back pain were female sex, older age, poor health status, smoking, alcohol consumption, insufficient physical activity, overweight or obesity, mental health problems, lower educational level or social class, dissatisfaction at workplace, poor social support and family financial problems. CONCLUSIONS The analysis shows a decreasing prevalence of chronic back pain from 2011 to 2018 in the adult population of Catalonia in all age groups and more significantly in women. An improvement of healthy lifestyle habits, social and occupational determinants, could have reduced the burden of chronic back pain in our community.
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Affiliation(s)
- Xavier Surís
- Rheumatology Department, Fundació Hospital Asil de Granollers, Barcelona, Spain; School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain; Servei Català de La Salut, Generalitat de Catalunya, Barcelona, Spain; Master Plan of Musculoskeletal Diseases, Departament de Salut, Barcelona, Spain.
| | - Vera Ortiz-Santamaria
- Rheumatology Department, Fundació Hospital Asil de Granollers, Barcelona, Spain; School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain
| | | | - Anna Mompart-Penina
- Direcció General de Planificació en Salut, Departament de Salut, Barcelona, Spain
| | - Marta Larrosa
- Master Plan of Musculoskeletal Diseases, Departament de Salut, Barcelona, Spain
| | - Assumpta Ricart
- Servei Català de La Salut, Generalitat de Catalunya, Barcelona, Spain
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